Housekeeper's Application Form

Personal Details

Surname *

First Names *

Address *

Town/Country *

Post / Zip Code *

Home telephone number

Mobile telephone number *

Email address *

Emergency contact name *

Relationship to you

Emergency contact number *

Date of birth *

Age *

Place of birth *

Nationality *

Gender * Female
Male

Passport ID number *

Passport date of issue *

Passport date of expiry (Please enter not applicable if you do not have a passport) *

Is visa work permit necessary? *

Marital Status * Single
Married
Divorced
Widowed

Do you have any children? * Yes
No

If so how old are they

Position Required

Position required *

Are you looking for a position that is * Live In
Live Out
Either

Are you willing to take a job involving some childcare * Yes
No

Minimum salary accepted per week or per hour (NET) *

Your Qualifications and Experience

Your level of education, and any school, childcare, cookery or first aid certificates you may hold

Your present occupation duties in brief and current salary

(IN ADDITION, PLEASE ATTACH A FULL CV / JOB HISTORY. YOU NEED TO EXPLAIN IN DETAIL ANY EXPERIENCE YOU HAVE OF CHILDCARE, (INCLUDING BABYSITTING), AS WELL AS ANY GENERAL HOUSEWORK YOU HAVE DONE, AND HOUSEKEEPING POSITIONS YOU MAY HAVE HELD).

Availability

Available to start from *

Minimum length of job required *

Maximum length of job required *

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Your Preferences

Will you travel with a family if required? Yes
No

Do you have any visa / passport restrictions on travel? Yes
No

What are these restrictions?

Do you speak any other languages?

I'm Happy To Work In a Family

2 adults with children Yes
No

2 adults with NO children Yes
No

Single father Yes
No

Single mother Yes
No

With a different religion to my own Yes
No

Will you work with a family with pets? Yes
No

Are there any animals you really dislike?

Would you help with pets as part of your job? Yes
No

More Details

Do you have any allergies? If so, to what, and to what extent?

Are you under medical treatment for any condition? Please explain

Are you vegetarian? Yes
No

If yes, would you work with a family who was not vegetarian? and cook meat and fish for them Yes
No

If no, would you work with a family who was? Yes
No

Are there any foods you never eat?

Do you smoke? Yes
No

How many per day?

Are you prepared to promise that you will not smoke at work or in the presence of the children? Yes
No

Driving

Do you have a current, full driving licence? * Yes
No

Is it valid for driving in the UK * Yes
No

Do you have any points or endorsements? Yes
No

If so, how many and for what?

Do you have your own car? * Yes
No

With rear seat belts? Yes
No

And Finally...

How did you hear of this agency? *

What other agencies have you contacted?

YOU WILL NOW NEED TO PROVIDE:

PHOTOGRAPHS (4 PASSPORT SIZED, SIGNED BY YOU ON THE BACK)
PROOF OF YOUR IDENTITY ( PASSPORT / ID DOCUMENT)
2 WRITTEN REFERENCES (NOT FROM FAMILY MEMBERS), WITH TELEPHONE NUMBERS
ANY RELEVANT CERTIFICATES (BOTH CHILDCARE AND FIRST AID)
CRB DISCLOSURE / POLICE CHECK CERTIFICATE
DRIVING LICENCE (IF APPLICABLE)
A CV, GIVING FULL DETAILS OF YOUR WORK HISTORY AND DUTIES.

IF YOU ARE AN APPLICANT APPLYING DIRECTLY TO NORMA LEWIS DOMESTIC STAFF AGENCY THROUGH THE WEBSITE, YOU WILL NEED TO FAX / SCAN / E-MAIL /POST THESE DOCUMENTS TO NORMA LEWIS URGENTLY, SO THAT YOUR APPLICATION MAY BE SUCCESSFULLY AND LEGALLY PROCESSED.

SUBMITTING THIS FORM IN ANY FORMAT TO THE NORMA LEWIS DOMESTIC AGENCY SHOWS THAT YOU HAVE READ, UNDERSTOOD, AND ACCEPTED THE FOLLOWING DECLARATION, AND WILL ABIDE BY IT.
IF DOWNLOADED, THIS DECLARATION IS TO BE SIGNED IN DUPLICATE, 1 COPY FOR NORMA LEWIS, AND 1 FOR THE APPLICANT:

I DECLARE THAT TO THE BEST OF MY KNOWLEDGE, ALL THE ABOVE INFORMATION IS CORRECT AND TRUE. SHOULD ANY INFORMATION CHANGE, I WILL NOTIFY NORMA LEWIS AGENCY IMMEDIATELY.
ONCE I HAVE BEEN OFFERED A POSITION, AND AFTER I HAVE ACCEPTED, I WILL NOTIFY THE AGENCY IMMEDIATELY.
I WILL NOT START MY NEW POSITION UNTIL AFTER I HAVE RECEIVED MY CONFIRMATION OF PLACEMENT FROM THE AGENCY.
I WILL PAY FOR ANY TELEPHONE BILLS INCURRED DURING MY PLACEMENT AS A HOUSEKEEPER
IF I AM UNHAPPY AND WISH TO LEAVE MY PLACEMENT I WILL TELEPHONE NORMA LEWIS. (TELEPHONE 0208 950 8611, MOBILE 07956 894589).
I WILL HAND IN A MINIMUM OF 14 DAY'S NOTICE TO THE FAMILY.
I UNDERSTAND THAT I CAN BE GIVEN NOTICE, OR SUMMARILY DISMISSED IF:
1. 1. I FAIL TO ABIDE BY THIS AGREEMENT
2. 2. I HAVE GIVEN FALSE INFORMATION ON MY APPLICATION FORM
3. 3. I START MY PLACEMENT BEFORE RECEIVING MY OFFICIAL CONFIRMATION FROM THE AGENCY.
4. 4. I BREAK THE LAW, OR ACT IN A WAY THAT ENDANGERS ANY CHILDREN IN MY CARE.

Name *

Date *

GENERAL INFORMATION

What Is A Nanny And What Is A Mother's Help

Openings For Agents

Agents Agreement

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Us

FOR APPLICANTS

FOR FAMILIES

Housekeeper's Application Form

Personal Details

Position Required

Your Qualifications and Experience

Availability

Your Preferences

I'm Happy To Work In a Family

More Details

Driving

And Finally...

GENERAL INFORMATION

What Is A Nanny And What Is A Mother's Help

Openings For Agents Agents Agreement Testmonials Families / Jobs Available Now Applicants Available Now Useful Contacts And Links Contact Us FOR APPLICANTS

FOR FAMILIES

Housekeeper's Application Form

Personal Details

Position Required

Your Qualifications and Experience

Availability

Your Preferences

I'm Happy To Work In a Family

More Details

Driving

And Finally...

Openings For Agents

Agents Agreement

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Us

FOR APPLICANTS